A health care provider’s relationships with managed care and other commercial and governmental third-party payors affect the entity’s viability, patient population and mix, revenues, and day-to-day operations.
We represent clients in all aspects of their dealings with and participation in third-party payment arrangements. Our clients include privately and publicly owned acute care hospitals (including academic medical centers, children’s hospitals, rehabilitation hospitals and psychiatric hospitals), multispecialty physician groups, suppliers, mental health providers and other specialized inpatient and outpatient providers.
Our services include:
- Contract negotiations
- Dispute resolution
- Management of issues and problems
- Compliance with applicable laws and regulations
- Helping clients achieve and maintain participation and accreditation for both commercial and government payment programs.
Our health care attorneys have successfully represented clients in their dealings with the Medicare and Medicaid programs (Medi-Cal in California), including payment and reimbursement, coverage issues and rulings, program participation and termination, and risk contracting. We regularly advise health care organizations in areas associated with regulatory compliance, including Medicare and Medicaid cost reporting, billing and coding, structuring transactions, and corrective actions.
Many of our health care attorneys handle administrative and judicial appeals relating to payments and compliance matters, including Medicare Administrative Contractors, Recovery Audit Contractors and other auditors, and advise as to internal and external investigations.
We can assist your organization by providing guidance in the following areas:
- Program eligibility, enrollment and exclusion
- Medicare/Medicaid reimbursement
- Managed care contracting
- Commercial payors